Individual provider Active NPI

Sujitha Sree Ketineni, M.D.

  • Hematology & Oncology Physician
  • Springfield, IL
National Provider Identifier
1285120725
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
036.156940 Issued in IL
Practice address
315 W Carpenter St # B
Springfield, IL 62702-4901
Phone
(217) 545-8000
Fax
(217) 545-1141
NPI assigned
Jul 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125071938 IL
Hematology & Oncology Physician 207RH0003X 036.156940 IL Primary

Addresses

Primary practice location

315 W Carpenter St # B
Springfield, IL 62702-4901

Mailing address

PO Box 19678
Springfield, IL 62794-9678
Phone (217) 545-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241220001097 CA Practitioner - Hematology/Oncology 7416207139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dignity Health Medical FoundationGroup PAC ID 7810800661, 1,211 clinicians

Practice addresses (Care Compare)

515 Fairchild CT
Woodland, CA 95695-5164
Phone (530) 668-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Medical Foundation CurrentSince Dec 9, 2024 Accepting new patients
Dignity Health Medical Foundation Current Accepting new patients
Dignity Health Medical Foundation CurrentSince Dec 9, 2024 Accepting new patients

Locations

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

515 Fairchild Ct
Woodland, CA 95695
Phone (530) 666-1631

632 W Gibson Rd
Woodland, CA 95695
Phone (530) 666-1631

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1285120725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19678",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949678",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W CARPENTER ST # B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024901",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETINENI",
        "first_name": "SUJITHA",
        "middle_name": "SREE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125071938",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036.156940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.